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COVID 19 and diabetes: a lethal partnership? How do we overcome this?

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By Dr. Kayathri Periasamy

With the latest wave of COVID-19 infections sweeping steadily across Sri Lanka, attention has been directed towards persons with uncontrolled, pre-existing conditions, particularly diabetes; as a sect most vulnerable to get severely ill or die because of complications caused by the virus. This has shed light on another growing concern among healthcare providers and patients, which is that patients suffering from diabetes or other chronic conditions are finding it increasingly difficult or are unable to access the medical care they require due to mandatory albeit essential curfew measures combined with a deep fear of contracting the virus in communal healthcare settings.

With a staggering 463 million adult diabetic patients present worldwide, World Diabetes Day 2020 – falling on the 14th of November- is a critical time for diabetes support communities and healthcare advocates to rally together to create awareness about this debilitating medical condition and push for progress in the standards of care and the better management of diabetic patients during a pandemic. In Sri Lanka alone, 1 in 10 adults are approximated to suffer from the disease. It is also then vital to look at ways to help stop more people from getting this disease, particularly at a time when ‘lockdown’ lifestyles are more often than not likely to be sedentary, unhealthy and stressful; an ideal background for a diabetes diagnosis.

Why is uncontrolled diabetes such a potent accelerant for COVID-19?

A recent study conducted by Lancet on Diabetes & Endocrinology screened over 61 million medical records in the U.K. to find that 30% of COVID-19 deaths can be attributed to people with diabetes. After accounting for factors such as demography and chronic medical conditions, the risk of succumbing to the virus was shown to be about three times higher for people with Type 1 diabetes and almost twice as high for Type 2, versus those without the disease. 

There appears to be two primary reasons driving this predicament. Over a lifetime, poor glucose control inflicts widespread damage in our systems which can lead to strokes, heart attacks, kidney failure, eye disease, and limb amputations. The linings of blood vessels throughout the body weaken to an extent where they can’t ferry necessary nutrients adequately. Inflammation is another byproduct of poor diabetes control, which makes the body ill-prepared for the onslaught of the viral disease. Secondly, the rich environment of elevated blood glucose present in diabetic patients, makes them prone to superadded bacterial complications during the viral infection. Many diabetics also tend to have other co-morbidities such as obesity, hypertension, and heart disease, which are all factors that aggravate complications during viral illneses. These problems are seen in any infections in the setting of diabetes and not only with COVID 19. The pandemic has just highlighted the difficulties of having diabetes

 

What precautions can diabetic patients take?

So during this pandemic, apart from strict adherence to general COVID-19 personal safety protocols such as strict social distancing and sanitization, it is important for patients to regularly monitor their glucose levels to avoid complications caused by fluctuating blood glucose. Proper hydration is essential for good health. It is also crucial to have access to a good supply of the prescribed diabetes medications and healthy food so that patients are able to correct the situation if blood glucose levels fluctuate. Finally, sticking to a comfortable daily routine, maintaining an exercise program even within the confines of your home, reducing excessive work and having a good night’s sleep can go a long way in keeping you strong. In essence, maintaining good blood sugar levels may be their best defense against severe COVID-19.

Disruption to continuity of care for diabetes patients

A rapid assessment survey conducted by WHO among Ministries of Health across many countries, focusing on the service delivery for NCDs during the COVID-19 pandemic, revealed deepening concerns that many people living with NCDs are no longer receiving appropriate treatment or access to medicines during the COVID-19 pandemic. The more severe the transmission phase of the COVID-19 pandemic, the more NCD care services were disrupted.

With our country currently in the cluster transmission phase and heading towards the community transmission phase due to the large and distant spread of the first-line contacts, the threat to NCD care and especially routine and emergency care of diabetes patients worries us physicians. As healthcare providers, we too are torn between the dilemma of not wanting to expose our patients to unnecessary hospital visits and the need to ensure that all our patients have continued access to their healthcare team along with a steady supply of medicines and other diabetes care products such as glucometer strips and insulin. Unfortunately, the delay in visiting their healthcare provider when they have symptoms of complications has caused many people to present late to the hospital with heart attacks or infections. A delayed presentation, weakens the patient further.

This disruption to healthcare services is foreseen to be a huge dilemma for patients and healthcare providers alike, especially when it comes to the care of patients with diabetes and other non-communicable diseases. In Sri Lanka, the Ministry of Health, is currently providing a number of telemedicine services and has opened avenues to deliver medicines to houses without diabetic persons having to visit crowded settings

 

How do we counter this?

At Healthy Life Clinic, we adhere strictly to COVID-19 safety operational health protocols established according to Ministry of Health (MOH), Epidemiology Unit. All incoming patients are screened by our nurses as soon as appointments are made over the phone, to understand the nature of their illness. If there is a worry that they could have contracted COVID-19 or have been in contact with such patients, they are given the opportunity to speak to the doctor first over the phone for a detailed history. Every patient will be consulted and no one is turned away from our care.

In order to help patients overcome barriers such as curfews or even the fear of entering communal healthcare settings, our experienced, highly-regarded team of consultants conducts telehealth consultations via established, trusted telemedicine partners such as oDoc and Mydoctor.lk to maintain continuity of care throughout this pandemic. We have also moved many of our long-standing diabetes care and weight management programs online, which have proven to be effective even in the absence of a physical meeting and examination. Additionally, our social media platforms and website are constantly updated to increase awareness about this condition, along with content that informs people about the proper management and prevention of diabetes – particularly when it is thus connected to COVID-19.

 

(Dr. Kayathri Periasamy is a consultant physician MBBS (UK), MRCP (UK), Board Certified in Int. Medicine (U.S.A). She is the founder of Healthy Life Clinic, Colombo 07.)



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Privatization option being considered for Sri Lankan Airlines – CEO Richard Nuttall

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By Hiran H.Senewiratne

The government is planning to restructure the national carrier, Sri Lankan Airlines, and privatization is one proposed option due to the current financial crisis, Sri Lankan Airlines Chief Executive Officer (CEO) Richard Nuttall said.

“We are now looking at the privatization option as well because the government wants to restructure Sri Lankan Airlines, which is now preparing for the in- coming tourist season. So far we have enough bookings, Nuttall said at a press conference yesterday, which was called to announce, among other things, that Sri Lankan Airlines is the official airline partner for the Sri Lanka’s Masters Hockey World Cup 2022 in England, which will be held from August 12-21 in Nottingham. The press conference was held at the Sri Lanka Institute of Tourism and Hotel Management auditorium.

Nuttall added: ‘We have 24 aircraft in the fleet, out of which three aircraft are not functioning as those engines have been sent to the Rolls Royce Company for overhaul purposes. At present the entire air industry is facing a unique crisis due to fuel issues. The high air fares are also troubling the industry but they will likely come down in the future.

‘Over the last two years, Sri Lankan tourism and the airline sector got badly hit and we are now in the process of putting infrastructure in place to revive the business and coming forward to sponsor the Masters Hockey World Cup 2022 at this critical juncture is intended to promote and attract tourists into Sri Lanka, which would in turn benefit the airline as well.’

Chairman, Sri Lanka Tourism Promotion Bureau Chalaka Gajabahu said that they, being the main sponsor for the Sri Lanka team, had seen an opportunity to promote Sri Lanka tourism at the World Cup to boost forex inflows at a desperate time amid an economic crisis.

“These hockey Masters could be the best ambassadors to do and their part to keep the nation’s flag flying high and to continue with their good work, Gajabahu said.

According to the chairman, this year they expect close to one million tourists to Sri Lanka and are now in the process of rolling out a 15 -16 month action plan.

‘Sports tourism can be a major way of creating unity and friendship with other nations and spreading a positive message about Sri Lanka to the world, giving a realistic image and a clear description about the island destination, he said.

“This is not a short term goal but rather a long term one because many of the foreigners who hear about Sri Lanka could visit the country in the future. We see it as a golden opportunity through this partnership, he added.

Sri Lanka’s premier paint company, Nippon Paint Lanka (Pvt) Limited, is a co-sponsor of the team.

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Heed people’s call for new political model

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The people of Sri Lanka in the past few months have declared that there can be no reliance on old politicians and political models any longer, and there should be innovative thinking, while paying prompt attention to global changes.

The Sri Lankan people have made these demands for the past few months in non-violent, peaceful means, but were provoked into violence by the state and the discredited politicians who engineered and provoked violence, to brutally quash the legitimate demands for change in the political culture in the country.

As such, the people should not pay any heed to calls by a President, who does not have the people’s mandate to make any requests, demands or pleas on the people.

The current president may be president in the eyes of the Constitution or law – but he will never be the president of the people in spirit.

Furthermore, the political circumstances which culminated in the current President’s ‘selection cum election’ to office, by the vote of 134 members of parliament, necessitates an urgent and immediate change in the Political Model practices in Sri Lanka.

As such, we the people call on the President to recognise the root cause of the current economic crisis in the country, as indeed a political crisis, and call upon him to play his role in solving both the economic and political problems by resigning immediately, and making way for a new political model. Therefore, his call for a new economic model does NOT make any economic or political sense in the absence of introduction of a new political model as demanded by the people.

Would appreciate it if you would bring this to the notice of your readers.

Dr RUVAIZ HANIFFA

(For and on behalf of people who want genuine change in the political culture of Sri Lanka)

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CSE’s bullish momentum continues; turnover hits Rs. 3 billion for fourth day running

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By Hrian H.Senewiratne

The CSE began on a mixed note due to witnessing profit- takings in certain companies but later the bullish momentum resumed and the turnover reached more than Rs 3 billion for the fourth straight day yesterday. The market was mainly driven by blue chip companies, especially Lanka- IOC, which became the most sought after of stocks due to high profits, stock market analysts said.

It is said that the Lanka IOC and CPC are making heavy profits because the global oil market has come down to US $ 102 per barrel (Singapore Plates price formula) . Sri Lanka’s Ministry of Power & Energy has authorized the establishment of 50 new filling stations by Lanka IOC, the local unit of the Indian Oil Corporation (IOC).

LIOC Managing Director Manoj Gupta toldy the media that advertisements on the filling stations will appear in a week or so. “Sheds cannot be opened overnight. We will put out the advertisements and open them in fifty locations. The Ministry of Power and Energy has given approval. We will put out advertisements in a week or so, he said.

Sri Lanka is in the midst of a fuel crisis triggered by forex shortages. This has resulted in LIOC increasing its share price by 16 per cent or Rs 18.25. Its share price stepped up to Rs 131.25 from Rs 113 yesterday after concluding share-trading on the floor, stock market analysts said.

AgStar and Lanka Lubricants’ share prices appreciated by more than 16 per cent. AgStar is engaged in the business of importing, blending and marketing of fertilizer products. The company’s segments consist of Trading and Processing and there was a share price gain by 16.5 per cent or Rs 1.50. Its share price moved to Rs 10.60 from Rs 9.10 due to the government’s decision to lift the import ban on certain fertilizers, such as, Glyphosate, market analysts said. Lanka Lubricants’ share price appreciated by 16 per cent or Rs 13.50. Its share price moved to Rs 94.70 from Rs 81.20.

Amid those developments both indices moved upwards. The All- Share Price Index went up by 89.6 points and S and P SL20 rose by 86 points. Turnover stood at Rs 3.3 billion, with a single crossing. The crossing was reported in Melstacorp, which crossed 667,000 shares to the tune of Rs 30 million; its shares traded at Rs 30 million.

In the retail market, top seven companies that mainly contributed to the turnover were; Lanka IOC Rs 1.5 million (12.1 million shares traded), Expolanka Holdings Rs 319 million (1.5 million shares traded), JKH Rs 199 million (1.6 million shares traded), LOLC Holdings Rs 132 million (235,000 shares traded), Melstacorp Rs 111 million (2.4 million shares traded), Browns Investments Rs 85.5 million (11 million shares traded) and LOLC Finance Rs 75.4 million (8.7 million shares traded). During the day 85.6 million share volumes changed hands in 28000 transactions.

However, foreign selling intensified last week with a net outflow of Rs. 475 million, thereby increasing the year date figure to Rs. 859 million. July saw net foreign inflow of around Rs. 784 million. According to stock brokers, the biggest foreign selling during last week was in Melstacorp (Rs. 415 million), followed by Expolanka (Rs. 62.2 million) and Windforce (Rs. 16 million), while net buying was seen in Richard Pieris (Rs. 25 million), JKH (Rs. 21 million) and Hayleys (Rs. 14 million).

Yesterday, the Central Bank announced the US dollar buying rate as Rs 357.14 and the selling rate as Rs 368.40. The rupee has begun to stabilize against the US dollar due to the prudential monetary policies adopted by the Central Bank, financial analysts said.

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